Shri Vile Parle Kelavani Mandal’s

NARSEE MONJEE COLLEGE OF COMMERCE & ECONOMICS, MUMBAI 400 056

APPLICATION FOR MEDICAL CERTIFICATE

From Mr./Miss.__________________________
Class: ___________Div.______Roll No._______
Address: _______________________________

________________________________

Date: __________________________________

Student Number:_________________________

To,
The Principal,
Narsee Monjee College of Commerce & Economics,
Mumbai 400 056.
Dear Sir,
I could not attend my regular classes from ___________ to _________ (both days
inclusive) on account of the following
illness______________________________________________

I have remained partially / totally absent from the

____________________________________________________________ Examination /
Test held on ___________ to _____________on account of the following health
problem
________________________________________________________________________
_________________________________________
Medical Certificate dates _______________ issued by Dr.
____________________________
_____________________________ as required by rules is attached.
 Yours faithfully,

(Signature of Student)

(Countersign of Guardian)
(P.T.O.)

….2….
Rules:

1. Fully completed and signed application form should be given in office during
office hours on any working day within THREE DAYS of resuming attendance.

2. An official receipt will be given by the office on submission of application. The

receipt should be preserved by the student.

3. The medical certificate submitted does not amount attending classes or

examination or test. It only explains the medical condition of student.

4. Medical Certificate without specifying the exact dates should not be accepted.

5. If student is absent for more than three days, details of medical report –
pathology test, X-ray reports etc. should be submitted.

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